Healthy Places and public health

Local government is once again a major player in the health arena. With a new public health duty and a leading role to play in the new Health and Wellbeing Boards (HWBs), councils have an opportunity to generate much greater efficiency and effectiveness.

Moreover, as this is the first time clinicians, politicians and local government officers have come together, there is a once in a lifetime opportunity to rethink and redefine preventative health interventions to radically improve the health outcomes of the local population. In a recent research report, we began to map out how local government could take up the role of the ‘health improving council’ implied by the recent reforms.

The new arrangements will certainly create opportunities, and there are reasons for optimism: among those involved in the agenda, our research reveals a relatively high degree of confidence (3.85 out of 5) in HWBs. However, it is already evident that creating stronger relationships across an increasingly complex health and social care sector will not be without its challenges. Sixty six per cent of survey respondents said that organisational differences were the most significant factor which might limit the effectiveness of their HWB.

Organisational divisions and territorialism in decision-making and budget-setting will be particularly problematic, particularly where hard choices have to be made to divert limited resources from existing services to new priorities. To encourage honesty in these ‘difficult conversations’, we recommend HWBs design ‘prenuptial agreements’ illustrating the commitment and contribution each board member is prepared to make to the board.

The effectiveness of HWBs will depend on their ability to engage with a wide variety of external stakeholders, which they can influence only indirectly. However as local government only has soft powers at their disposal, there is a danger of public health not being prioritised by other local agencies.

We propose legislating a “duty to cooperate” with HWBs, similar to that in the Localism Act 2011, for public bodies. We further propose the HWB chair should have a ‘call in’ power to local authority departments commissioning services (for example in relation to the use of CIL) to ensure local authority delivery takes the Joint Health and Wellbeing Strategy into account.

At the heart of the changes lies an opportunity for a new era of public involvement in health services and prevention. By engaging residents, particularly ‘hard to reach’ groups, HWBs will be able to design interventions that meet immediate needs but also reduce demand in the long term. To ensure public engagement is prioritised, we recommend that HWBS should publish an explicit strategy for public involvement in their work.

Our research found that budget pooling is seen as the most effective tool available to ensure effectiveness of HWBs. However 94 per cent of respondents felt that central government has provided insufficient incentives for integrated working. If local authorities are to succeed in reducing demand for acute services, they will need to shift resources to prioritise preventative measures. We suggest government should create “Health and Wellbeing Deals” whereby HWBs bring forward plans for pooling in exchange for the removal of regulatory or legal barriers to pooling as well as potential top-up funding for pooled budgets from central government.

The reforms in public health offer a real opportunity to reshape public services and drive preventative healthcare into everything local authorities do. However without tougher power for HWBs, they risk becoming a talking shop. We therefore strongly urge the government to legislate for a small number of hard, statutory powers which could turbo charge the new boards and ensure the emergence of a new generation of health improving councils.

Disclaimer

The aim of this blog is to encourage discussion and debate on public health issues. The views expressed here are the personal views of authors, and the content does not reflect the official position of the Faculty of Public Health. However, discussion generated here may be used to influence the development of organisational policy.